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Navy and Marine Corps Medical News 

September 1, 2000 

Navy and Marine Corps Medical News (MEDNEWS) is a weekly 
compendium of news and information contributed by commands 
throughout the Navy medical department . Information contained 
in MEDNEWS stories is not necessarily endorsed by Navy Bureau of 
Medicine and Surgery (BUMED) , nor should it be considered 
official Navy policy. 

BUMED distributes MEDNEWS to Sailors and Marines, their 
families, civilian employees and retired Navy and Marine Corps 
families. Further distribution is highly encouraged. 

Stories in MEDNEWS use these abbreviations after a Navy 
medical professional ' s name to show affiliation: MC - Medical 
Corps (physician) ; DC - Dental Corps; NC - Nurse Corps; MSC - 
Medical Service Corps (clinicians, researchers and 
administrative managers) . Hospital Corpsmen (HM) and Dental 
Technician (DT) designators are placed in front of their names. 


Contents for this week's MEDNEWS: 

- Five steps to safer healthcare 

- EDIS : A major quality of life program for Navy families 

- Physical therapists offer hands on help to the Fleet 

- Anthrax question and answer 

- TRICARE question and answer 

- Healthwatch: Rub-A-Dub: Wash your hands of dirt and grime 

Headline: Five Steps to Safer Healthcare 

By Army Staff Sgt. Kathleen T. Rhem, American Forces Press 

WASHINGTON - It 1 s your health and Defense medical officials 
want you to know a few simple steps you can take to safeguard 
yourself as a DoD healthcare patient . 

"We want to make people understand that there are certain 
things they can do that will minimize patient errors and, even 
more, will help draw them into their own care, " said Dr. John 
Mazzuchi, deputy for clinical and program policy in the Office 
of the Assistant Secretary of Defense for Health Affairs. "Each 
person is responsible for his or her own health care, too. We 
want them to be in a partnership with their doctor. " 

To help build this partnership, the Quality Interagency 
Committee (QIC) came up with a list of five things people can do 
to safeguard themselves from medical errors. The QIC is a group 

of healthcare professionals from several federal agencies that 
deals with quality and safety issues in medicine. 

1 - Speak up if you have questions or concerns. Mazzuchi 
said he wants patients to understand that asking questions 
shouldn't be seen as challenging physicians . "I'm sure it can 
be somewhat uncomfortable for a young enlisted person or a 
spouse of a young enlisted person to be sitting in front of a 
full colonel who's the physician and start asking questions, " he 

Mazzuchi stressed he's not suggesting patients question the 
doctor's intelligence, integrity or motivation. But if you have 
questions as a patient, you need to get those questions 
answered, he said, noting that patients do a better job of 
following instructions if they understand the instructions 

2 - Keep a list of all medications you take. "Clearly, 
medication errors are a major concern because we write so many 
prescriptions, " Mazzuchi said. Because medications can 
counteract each other or cause a serious reaction when combined, 
he said it 's critical for patients to tell their doctor and 
pharmacist what medications they're taking, including over-the- 
counter drugs and supplements, and any allergies they might 

3 - Make sure you get the results of any test or procedure. 
"Don't assume that because the doctor has not gotten back to you 
in two weeks, everything was fine, " Mazzuchi said. "That doesn't 
mean that it couldn't have been lost in the mail or misplaced. " 

Individuals should call their healthcare provider and ask 
for an explanation of results they don't understand. "If a 
result comes back that seems strange, I think it 's important for 
a patient to pick up the phone, call the doctor, nurse or lab 
tech and say, 'I don't understand these results. Can you go 
over them with me?'" 

4 - Talk with your doctor or healthcare team about your 
options if you need hospital care. "Certain hospitals do a 
better job with certain types of surgery than others, " Mazzuchi 
said. "So whenever there's an option, you'd want to go to the 
hospital that has a record for the best outcomes . " 

5 - Make sure you understand what will happen if you need 
surgery. "If something different happens from what the 
physician tells you to expect, then you need to bring that to 
the physician's and nurse's attention immediately. You may be 
having complications , and you need to say so right away, " 
Mazzuchi said. It 's easier to treat you when a problem is 
brought up right away, he noted. 

Mazzuchi said DoD is also working to educate healthcare 
providers on these issues to make the partnership between 
provider and patient easier. "We are educating both those 
physicians who are coming up through medical school and those 
who are already in practice about the need to go over options 
and to bring the patient into the health decisions that are 
being made, " he said. 

Medical errors might happen, but there are ways to mitigate 
their seriousness. "Patient errors don't happen because you 

have bad people, they happen because health care providers are 
human beings and they make errors, " Mazzuchi said. 

"But when you're the most informed, when you really know 
what 's going on about your healthcare, when you understand your 
options, when you understand what 's probably going to happen to 
you and what to expect after you recover, when you understand 
what your lab results are and what they mean, you can take 
better care of yourself, " he said. 


Headline: EDIS : A major quality of life program for Navy 

By Lt. Cmdr. Mark C. Russell, MSC, and Cmdr. Robert Buckley, MC, 
U. S. Naval Hospital, Yokosuka 

YOKOSUKA, Japan - The Navy has one of the finest quality of 
life programs to be found within the Department of Defense or 
civilian sector — the Educational and Developmental 
Intervention Services (EDIS). U.S. Naval Hospital, Yokosuka, 
Japan, is responsible for the EDIS program in mainland Japan. 

EDIS is a congressionally-mandated, DoD-wide program 
dedicated to providing early intervention and medically-related 
services to eligible military and civilian members and their 
families . 

The goals of EDIS are to: improve the functional and 
adaptive skills of infants and toddlers with developmental 
delays; maximize the learning potential of school age children 
with disabilities ; empower families to become active 
participants in their child's education and development; and 
enhance the independence of children with disabilities to enable 
them to function with their peers. 

EDIS Japan operates on six DoD installations across 1500 
miles and includes Air Force, Army, Navy, and Marine Corps 
communities . Family members of Sailors and Marines can receive 
comprehensive health related services by well-trained, dedicated 
multidisciplinary teams. 

Each clinic has a full complement of EDIS professionals 
including occupational therapists, physical therapists, speech 
and language pathologists , child psychologists, social workers, 
community health nurses, and early childhood special educators. 
Audiology, child psychiatry, and developmental pediatrics 
services can also be provided. 

Active duty service members also benefit from space A 
services for audiology, mental health, physical therapy, and 
occupational therapy provided by EDIS health care practitioners. 

Given the overseas environment and forward-deployed status 
of our families, along with the unique stressors associated with 
living in Japan, these services constitute a major quality of 
life program for active duty families . 

In 1993, virtually no space A services were made available 
to the overseas community in Japan. This resulted in the early 
returns of 78 family members and typically the active duty 
member as well . EDIS offers local commands significant cost 
savings by preventing the need for early return to families and 
personnel transfers . 

One of the components of the EDIS program is the ongoing 
"child find" activities. The purpose of child find is to 
identify children with special needs as early as possible in 
order to deliver interventions designed to remediate a child's 
disability thus improving their educational and developmental 
prognosis . 

For many childhood problems , early intervention is critical 
for a favorable long-term outcome. In Japan, EDIS providers are 
engaged in active community-wide child find activities by 
conducting developmental screenings at the Child Development 
Centers, health fairs, and primary care clinics. Public 
announcements are also made through various written and visual 
media including television ads, to inform the community about 
available services. 

EDIS is a cost effective and major quality of life program, 
especially for families stationed overseas. Both the quality 
and scope of services provided by EDIS is comparable to, if not 
exceeding that which our military families receive in the United 
States . 


Headline: Physical therapists offer hands-on help to the Fleet 
By Bill Doughty U.S. Naval Hospital, Yokosuka 

YOKOSUKA, Japan - Broken bones, torn muscles and twisted 
necks and backs - welcome to the snap-crackle-and-pop world of 
physical therapy, where the mission is to get people healthy and 
back on their feet as quickly as possible . 

U. S. Naval Hospital, Yokosuka, Japan, recently welcomed a 
new physical therapist, LTJG Jacqueline Pollock, who is working 
side by side with the Fleet to heal people and prevent injuries . 

"This is my first duty station, " she said. "Everybody here 
is so helpful and willing to give you a helping hand any time 
you need it. " 

A cadre of Senior Hospital Corpsmen - trained physical 
therapy technicians - assist LTJG Pollock. She also works hand- 
in-hand with LTJG Doug Hood of Educational and Developmental 
Intervention Services and LT Bryan Bost, physical therapist of 

Lt . Bost provides musculoskeletal screening and physical 
therapy on board thecarrier. 

"My job aboard the Kitty Hawk is to reduce the number of 
lost work days that our sailors have and to get them back to 
work as quickly as possible, " LT Bost said 

When the ship is in port, LT Bost provides physical therapy 
to patients at the Naval Hospital. 

"It gives my patients from the Kitty Hawk a chance to come 
over here and do a much more extensive rehab than possible 
aboard ship, " he said. 

Physical therapists play a critical role in helping commands 
maintain their operational readiness . Their patients come from 
a very physically active community . 

"We have, on board Yokosuka, a young population who like to 
get out and play football, softball, soccer, baseball and lift 
weights, " said Lt. Bost. "You name it, they like to do it. Not 

to mention the new PRT standards which require us to be in a lot 
better shape. " 

Both physical therapists are actively working with area 
fitness coordinators, helping commands get ready for the Navy's 
Physical Readiness Test . 

"One of my main focuses is patient education, " said LTJG 
Pollock. "We're trying to help the fitness coordinators educate 
their people on what they can do to prevent injuries before they 
start exercising. " 

Physical therapists and technicians have a vested interest 
in teaching proper exercise technique, preventing injuries, and 
reducing the " snap-crackle-and-pop . " 


Headline: Anthrax questions and answer 

Question: Does anthrax vaccine protect against disease if 
someone inhales anthrax spores? 

Answer: The original studies of anthrax vaccine showed 93 
percent fewer anthrax infections (combining both cutaneous and 
inhaled cases of anthrax) among vaccinated people, compared to 
unvaccinated people. 

In those original studies, no cases of inhaled (inhalation) 
anthrax occurred among vaccine recipients, while five cases of 
anthrax occurred among unvaccinated or incompletely vaccinated 
people. This difference involved too few people to be 
statistically conclusive, although the trend is obvious. 

It is unethical to intentionally expose human beings to 
inhaled anthrax to test the vaccine. Instead, anthrax vaccine 
was tested on animals. After 45 animals received one or two 
doses of vaccine, 44 of 45 survived aerosol challenge in full 
health. That one animal died from anthrax exposure two years 
after the second dose of vaccine. This illustrates the 
importance of annual booster doses of anthrax vaccine. 

These data lead us to expect that anthrax vaccine would be 
quite effective in preventing inhaled anthrax. 


Headline: TRICARE question and answer 

Question: I prefer to see an off base/post civilian doctor. 
How do I do that and do I have to pay? 

Answer: You can enroll in TRICARE Prime and request a 
Primary Care Manager form the civilian TRICARE network. 
Otherwise, you can see any physician you want and pay an annual 
deductible plus part of the cost . Or, you can choose a civilian 
physician from a select network and pay somewhat less. These two 
choices are the TRICARE Standard or TRICARE Extra options, 
respectively . 


Headline: Healthwatch: Rub-A-Dub: Wash Your Hands of Dirt and 

By JOl M. C. Mercado, Naval Hospital Pensacola 

For most people hand washing is a subconscious act that 
takes place after using the bathroom or before a meal . But 

proper hand washing can really be a matter of life or death. 

Hungarian doctor Ignaz Semmelweis first recognized the 
importance of hand washing as a means of infection control while 
working at a hospital in Vienna, Austria during the 1800s. 
Semmelweis noticed an alarming number of healthy, new mothers 
dying within days after giving birth. 

He discovered that student-doctors working in the morgue 
were also treating the women. However, the doctors were not 
washing their hands. Semmelweis suspected they were spreading 
germs from the dead to the new mothers and insisted that they 
begin a practice of washing their hands before treating 
patients . 

After educating the doctors of his findings, and 
incorporating regular hand washing practices between patients, 
Semmelweis saw the mortality rate of the maternity ward drop 
dramatically . 

Though times have changed and medicine has advanced greatly, 
the Association for Professionalism in Infection Control and 
Epidemiolgy maintains that hand washing remains the most 
powerful defense against infections. 

"Germs are all around us and come in different forms, " says 
Veronica Hagann, infection control coordinator at Naval Hospital 

Germs from other people can linger anywhere; the office 
phone, door handles, shopping baskets, money, even the button 
you push when you call for an elevator. These are items people 
touch and each time they do, they leave their germs and take 
away others. 

"This is how a lot of common illnesses are spread, " 
continues Hagann. "Airborne viruses include tuberculosis and 
measles, which are released into the air when an infected person 
exhales or coughs. Droplet viruses, caused by sneezing and 
coughing include meningitis, pneumonia and the flu. Contact 
illnesses include staph infections, food poisoning, pink eye, 
chicken pox and colds, " said Hagan. 

You can unknowingly come in contact with these germs. One 
simple rub of the eye or bite of a sandwich using unwashed hands 
can introduce any of a number of illnesses into your body. The 
odds of you or your family catching any of these are greatly 
reduced simply by washing your hands, according to Hagan. 

Handwashing removes dirt, organic material and transient 
microorganisms . The most important element is friction. You need 
to rub your hands together with soap for 10 to 15 seconds to 
loosen up the grit and germs and then rinse. 

"It is not the soap that kills the germs, " said Hagan. "It 
is the act of rubbing the hands that loosens the germs and 
rinsing washes the germs away. " 

It is important to wash your hands regularly throughout the 
day. After cleaning the house, petting a dog or returning from 
an outing, it is important to wash away the germs that you have 
accumulated on your hands. It especially needs to be done before 
cooking or eating. 

"In general, normal healthy human skin acts as a barrier to 
keep germs out. Dry or cracked hands have less resistance to 

germs. If you have cracks or cuts in your skin, germs have 
access into your body, " said Hagan. 

-USN - 

Comments about and ideas for MEDNEWS are welcome. Story 
submissions are encouraged. Contact MEDNEWS editor, at email:; telephone 202-762-3218, (DSN) 762, or 
fax 202-762-3224.